I can’t tell you how many zillion times I’ve had to sit on a body waiting for an M.E. to show up. In a large metropolitan area such as this it can take all day.
I have no personal experience but here in the UK you should call 999 and ask for an ambulance.
When you get through to ambulance control the first question they ask is “Is the patient breathing?” If you say “No” they will still send paramedics on blue lights in case you are mistaken. Assuming that there are no suspicious circumstances, (not the result of an attack etc) the paramedics will ask the patient’s doctor to come and certify death.
It’s actually pretty simple. It all depends on who is going to sign the death certificate. I’ve handled at least many dozens of cases over a few decades as a cop.
If they are under hospice care we would get called there and just take a report. The hospice doctor will be signing the death certificate. The doctor is usually not there it’s a hospice nurse in communication with the doctor. No one is coming to attempt to resuscitate. The hospice will make sure all the appropriate DNR paperwork is in place. The only time something further would happen is if there was something suspicious like a knife sticking out of the patient. We call that a “clue.” It never happened in my career. We ask if the family needs anything but the hospice always has that covered.
Outside of hospice everyone will honor a DNR. It does have to be physically present. Verbal DNRs from someone at the scene won’t help.
If there are obvious signs of death like cold to the touch or the start of rigor resuscitation will not start. If down time has been short and there are no obvious signs of life CPR will start in the absence of a DNR. Even with obvious signs of death the paramedics will come. In my area they are responsible for the death pronouncement. They hook up the patient to telemetry and contact the doctor at the hospital. The doctor then gives the official time of death.
After the pronouncement is made the medical examiner is contacted by phone. The officer on the scene gathers as much information as they can including health issues and which doctor has been caring for the patient. The ME will contact the doctor by phone and if the doctor is willing to sign the death certificate then the body is released to the family. If no doctor is available or willing to sign the death certificate then the ME comes for the body. During the officer’s investigation at the scene if it appears to be foul play, a suicide, a drug overdose, a child death or several other things the ME will come out regardless.
I guess the bottom line is if you they are under hospice call the hospice and they will know what to do. If there is no hospice call 911 because that’s how you start the process to get the pronouncement and death certificate.
Local variations in procedure apply.
My mom died at home. It wasn’t unexpected, but for some reason, my dad never enrolled her in a hospice program. He called 911, and when the police showed up they treated it like a criminal investigation, going all over the house, taking pictures, asking questions. Part of the problem was that my dad was a hoarder, and the police were concerned about the condition of the house and whether she died of neglect. One question they asked was when she last saw a doctor. It was less than two weeks before she died. They did eventually conclude that no crime had happened. They called the funeral home of our choice, and someone came and took her.
I suppose my dad could have called the funeral home directly, instead of calling 911. In that case, though, the funeral home would probably have called 911 themselves. Someone had to declare my mom dead. And despite how hard it was on us, the police really do have to investigate a death in a situation like that.
My dad died in hospice. My goal was for him to die at home. I wasn’t quite able to accomplish this. At the very end it got to be too much for me to care for him at home, so I had him transferred to a hospice facility. He lasted about four hours there before he died. If I’d known he was that close, I’d have let him die at home.
The people in the hospice program told me not to call 911. They said I should call them directly for any problem, including death or impending death. They gave me a 24/7 number to call, and also a supply of morphine to use when it looked like he was going into the final phase. I mentioned to them that the police came when my mom died, and they told me that wouldn’t happen with my dad in hospice if I called them.
If you’re caring for someone with a terminal illness, I strongly advise you to use a hospice program if it’s possible. The program my dad was in supported us in many valuable ways, and gave me legal cover when my dad finally did die.
Then it sounds like you should be in touch with hospice care.
The frail elderly person with known health problems doesn’t need to actually go into hospice. They can get care from their home.
And then there is a point of contact for when they do die.
Is in home hospice still available for somebody who is very elderly, and sickly, but not suffering from any known imminent risk of death?
Since this is more advice and opinion than factual, let’s move this to IMHO (from FQ).
I’m sure there are exceptions, but generally hospice care requires a specific diagnosis ( frail and elderly doesn’t qualify) and a life expectancy of six months or less and I don’t think it’s different because it’s at home.
I can only speak to the laws and procedures here in Ontario, but they’re pretty much in line with what’s already been said.
In the general case, with one notable exception, in the situation described the caregiver must call 911. In the circumstances described in the OP, around here 911 would dispatch all three emergency services – police, ambulance, and fire rescue (the latter is always dispatched with ambulance calls, for various reasons).
What happens after that will vary by circumstances, and may very much depend on whether or not the patient had a living will with a DNR stipulation, and on local laws governing DNRs.
The one exception to this is the one outlined by @LSLGuy and others – if the patient has been diagnosed as terminally ill and is under home hospice care, sometimes called home palliative care. This should almost always be the case in the kinds of circumstances described by the OP. In that situation the patient will be getting regular visits from nurses, a pallliative care physician, and possibly a home care worker and others. There will be a procedure in place to contact the organization, or the palliative care physician directly, in case of death. The doctor would issue a death certificate, allowing a funeral home to then remove the body.
I don’t know about saying home hospice should almost always be in place for an elderly frail person with medical conditions ( which is what was described in the OP) - my 84 year old mother is somewhat frail and has health conditions. She might die in six months - or she might live mostly independently for another ten years.
There is always the odd case that doesn’t conform. The family was down at my MIL’s house when we - including her - made the decision to transfer her to hospice care. It was previously arranged, so we called the company and they sent out an ambulance for the transfer.
My MIL died before the ambulance arrived. They just found her in the bedroom dead - we thought she was taking a nap. I don’t recall anybody being called. The ambulance whisked her away, maybe directly to the funeral home.
That was oddly reminiscent of my mother. She was in the hospital after knee replacement surgery, but scheduled to be moved to a nursing home. During the night before the move, she died. Again, if any calls were made it wasn’t by me.
Ah, I figured there were certain qualifications, but I wasn’t sure. Ignorance fought!
Yes, it’s possible that the OP example would not have involved home hospice care. In any case, the main point I was making is that calling 911 is legally mandatory in my jurisdiction and probably most others, with the sole notable exception of the patient being under home hospice care with all the attendant prior arragements.
My mom is receiving home hospice care now at age 94 due to loosing her ability to walk or go to the bathroom on her own. She has been in and out of the hospital numerous times over that last couple of years for UTI infections.
My brother is retired and living with her and the hospice care helps, but it is still a drain on him. We are looking at nursing homes, but the hospice told us if she loses any more weight they will take her in to their facility.
When my grandmother died at home in her sleep my uncle called the hospice nurse that had been taking care of her. The nurse came in, examined Gran and said she had passed and then called the funeral home for us. The funeral home came and got her from there.
Just for clarification, that obviously depends on the jurisdiction. Here in Ontario, there’s no clear distinction between home care provided to the elderly and hospice care. Home care is a service of the Ministry of Health that provides visits from nurses, personal care workers, and nutritionists, as well as necessary medical supplies, to the elderly. At some point it can transition to the equivalent of the US “home hospice care” if a palliative care physician becomes part of the rotation, which would happen with a terminal illness diagnosis, but it’s all part of the same program. The key distinction regarding the OP’s question is whether or not it’s transitioned to the palliative care stage. If not, then calling 911 and all the consequent drama is mandatory.
This happened to someone in the family a few years back. 911 (and other relatives) were called. The EMTs confirmed death. They left. A funeral home was called and from there the usual events took place. Two of the people involved are much more responsible than the others so they took care of the basic initial stuff and most of the later estate stuff.
Thank you all for the replies, very useful information.
As I’m sure you’ve guessed, this question is because we are looking at a situation of this type. One of my aunts (well, a sort of step-aunt) is clearly in the winding down part of her life. She has lost significant weight over the past 18 months, and now suffers from what she calls “dizzy spells,” but absolutely refuses to move into a care home of any type. “This is my home. I’ve lived here for the past forty years and if I die here, fine by me.” And yes, she’s mentally sharp. Her memory is way better than mine!
We (assorted family members who live reasonably near by) do our best to take care of her. We do her grocery shopping, drop off precooked meals, clean her house, pick up her medications, ferry her to md appts, and all the rest. There’s enough of us that it’s not an overwhelming burden.
But one problem is that she doesn’t have a medical power of attorney. She’s convinced that if she appoints someone, they will inevitably use that power to extract her from her home, willy nilly.
This might be true. She has a number of serious conditions, heart valve problems, high blood pressure, diabetes, and stage three kidney disease. I’ve personally spoken with her main doctor. He basically says he would not be surprised if she were to die at any time, though he doesn’t want to guess which would most likely kill her nor when it would happen. She’s been diagnosed with all those things for at least six years now.
So. We are just basically waiting for something definitive to happen, something that would make her GP insist she HAS to go into care RIGHT NOW. Unfortunately none of us are in a position to simply move in with her, due to other family situations.
I just keep having anxious spells when it’s my turn to drop by her house to ‘visit’ (check up on) her. And wondering what I (or another of the gang) must do if the day comes she just doesn’t wake up.
Sounds like 911 is the answer, unless the ‘qualifies for hospice’ event happens earlier.
That is an entirely reasonable choice. She is entitled to die at home if she wants to, even if this means dying sooner than she might have if forced into a care home.
I would ascertain they were really dead (no pulse, no pupil response, etc.). Then I would possibly call the people they were close to. Then I would light some incense and a candle and sit down to meditate with the body for awhile. There is no hurry, after death. No hurry at all. Relax. It’s over now.
Buddhists usually pray with the body for three days before burial. Jewish burial laws require burial within 24 hours, so it would depend on the person’s faith, if any.
I have found that rushing to call professionals to take charge of death (I’ve been part of those kinds of decisions) makes you feel helpless and awkward and lost. And there’s no real point to it, except fear of being with death. A lost opportunity to sit with someone’s passing and experience what it has to teach.
Dunno if this helps, but medical power of attorney can prohibit this, if she wants. That is, it can be specific to her wants and needs. It could keep her in her house while at the same time designate someone to make medical decisions for her about things like life support and medications should she lose the ability to make those decisions for herself. Have you suggested this to her?
Does she at least have an advanced directive?